Gout Culprit Promising as Acute Stroke Tx

SAN DIEGO -- Uric acid given along with thrombolytics in the first hours after an ischemic stroke showed a signal for improved recovery, a Spanish proof-of-concept trial showed.

The rate of near full recovery at 90 days was 39.3% with the powerful antioxidant compared with 33% on placebo instead, Angel Chamorro, MD, PhD, of the Hospital Clinic in Barcelona, Spain, and colleagues reported here at the International Stroke Conference.

Secondary outcomes for worsening at 3 days and disability in activities of daily living and neurologic functioning at 90 days all favored uric acid as well, although it was only significantly protective against early worsening (P=0.025).

The biggest benefits were among women and patients with high blood sugar -- associated with lower uric acid levels and higher oxidative stress, respectively -- and in moderate stroke.

The findings provide the proof of concept and safety needed to move on to the next stage, with a planned 1,500-patient clinical trial, Chamorro noted at a press conference for the late-breaking study.

Uric acid has gotten a bad reputation as the culprit in gout, but it only causes problems when high concentrations crystallize out into joints over the longer term, Chamorro told MedPage Today.

Brief, acute administration wasn't associated with any increase in gout over 90 days (0.5% versus 2.0% on placebo, P=0.194). Nor were there significant increases in early brain bleeds or death with the antioxidant, which was given within 4.5 hours after stroke onset in patients randomized at 10 Spanish centers.

A similar strategy with uric acid is being tried in Parkinson's disease, noted conference chair Steven Greenberg, MD, PhD, of Harvard and the Massachusetts General Hospital Stroke Research Center in Boston.

"The common idea is that a protective agent may be beneficial for both," he told MedPage Today at the press conference, calling uric acid "an exciting potential new tool for protecting brain cells."

Chamorro agreed that uric acid could touch on a mechanism that would benefit other conditions, too, such as traumatic brain injury and intracranial hemorrhage.

He pointed out that the benefit of uric acid appeared even in patients in his trial who did not show restoration of flow through the infarct after tPA administration.

The results don't suggest stopping or avoiding uric acid-reducing gout medication for patients at high stroke risk, he cautioned.

However, if a stroke patient came in on gout medication, Chamorro said he would stop that drug to help their chances of recovery from the more acute danger.

The study was supported by grants from the Institute of Health Carlos III of the Spanish Ministry of Health and Fundacion Doctor Melchor Colet.

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